Surgical Treatment Options

We are now able to provide many people who have chronic weight gaining conditions or who are obese, weight loss surgery. With the advancements in technology, there are a variety of techniques that are now minimally invasive and which pose less of a risk to patients. In addition, patients who undergo minimally invasive surgery will recover faster with the same results, than someone who undergoes a traditional open bariatric surgery.

For those requiring weight loss surgery, The Live By Losing program is the optimal solution. Dr. Michael L. Green, Jr. is one of the leading authorities on bariatric surgery in all of North Texas. He is a member of the American Society for Metabolic and Bariatric Surgery (ASMBS), Society of American Gastrointestinal Endoscopic Surgeons and a Fellow of the American College of Surgeons. He has also completed an Advanced Laparoscopic and Bariatric Surgery Fellowship at Providence Hospital, affiliated with Howard University in Washington, D.C., after completing a 5 year residency at St. Francis Medical Center in Peoria, Illinois. 

 

Minimally Invasive Procedures Defined

Minimally invasive surgery also known as laparoscopic surgery is that which only creates the smallest surgical incision possible. Minimally invasive surgery often uses scanners, cameras and robotics to perform the surgery without the surgeon’s hands physically inside the patient. Surgeries that can fall into the category of minimally invasive weight loss are procedures such as a laparoscopic Roux-en-Y Gastric Bypass, laparoscopic duodenal switch surgery, laparoscopic sleeve gastrectomy and laparoscopic vertical banded gastroplasty. The benefit to laparoscopic surgery is a minimal incision site concluding a reduced risk of infection, which allows for a shorter hospital stay and faster recovery overall.

Recovery

Recovery periods and healing may vary from person to person and may depend on your overall (pre-surgery) health, weight and type of surgery. Generally it takes 1 to 3 weeks to recover from laparoscopic gastric bypass and 2 to 6 weeks to recover from open gastric bypass surgery.

Risk

Minimally invasive weight loss surgery is considered much lower risk than traditional (open procedure) surgery. The potential for infection is much lower, in addition to the wounds closing more readily.

Gastric Restrictive Procedures

Adjustable Gastric Banding

A gastric banding procedure is a purely restrictive surgical procedure in which a band is placed around the uppermost part of the stomach. Food digestion occurs through the normal digestive and absorption process.  Gastric banding provides a sense of satisfaction with minimal food intake.

Advantages

  • It restricts the amount of food that can be consumed at a meal.
  • Food consumed passes through the digestive tract in the usual order, allowing it to be fully absorbed into the body.
  • Band can be adjusted to increase or decrease restriction.
  • Surgery can be reversed.

Potential Risks

(The following are in addition to the general risks of surgery.)

  • Gastric perforation or tearing in the stomach wall may require additional operation.
  • Access port leakage or twisting may require additional operation.
  • May not provide the necessary feeling of satisfaction that one has had “enough” to eat
  • Nausea and vomiting
  • Outlet obstruction
  • Pouch dilatation
  • Band migration/slippage

Sleeve Gastrectomy Surgery

This procedure was initially viewed as the first part of a two-stage weight loss procedure. It has proven for many to be the primary surgical procedure for weight loss and long term management making the second stage of the procedure unnecessary. The procedure involves removing 70-80% of the stomach. Data has shown the sleeve gastrectomy is currently growing in popularity as a safe and extremely effective procedure for long term success. 

Advantages

  • Lower risk of nutritional deficiencies because it does not reroute the small bowel
  • Alternative restrictive procedure for patients without having a foreign body in place

Potential Risks

  • Leak across staple line
  • Nutritional Deficiencies
  • Heartburn or gastroesophageal reflux/potential gastritis
  • Gastritis

Combined Gastric Restrictive & Malabsorptive Procedures

Gastric Bypass Roux-en-Y

In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health guidelines, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing a percentage of calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

  • The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
  • One year after surgery, weight loss can average 77% of excess body weight.
  • Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
  • Studies show there is a resolution of obesity related diseases such as diabetes, high blood pressure, heartburn (GERD), sleep apnea, etc.

Potential Risks

  • Marginal Ulcers
  • Internal Hernias
  • Malabsorption of Vitamins & Minerals

Duodenal Switch (DS) Procedure

Biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect. The restrictive portion of the surgery involves removing approximately 70% of the stomach and most of the duodenum.  The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat.  As a result, following surgery, these patients absorb only approximately 20% of the fat they intake.

Advantages

  • Type II Diabetes and hyperlipidemia are immediately cured following surgery in 99% of patients
  • Other obesity related diseases such as sleep apnea and hypertension are drastically reduced following surgery
  • Patients do not experience dumping syndrome
  • Diet following the DS is more normal and better tolerated
  • The malabsorptive component is fully reversible

Potential Risks

  • Bowel obstruction, stomach perforation and gastrointestinal leaks
  • Marginal ulcers
  • Malabsorption of vitamins & minerals
  • Low blood sugar (hypoglycemia)
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